© 1993 British Society for Rheumatology
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VALIDITY AND RELIABILITY OF THREE METHODS USED IN THE DIAGNOSIS OF RAYNAUD'S PHENOMENON
1Arthritis and Rheumatism Council Research Unit, Manchester University Medical School
2Department of Rheumatology, Royal Free Hospital London
3Manchester Royal Infirmary
4Coventry and Warwickshire Hospital
5Royal Bath Hospital for Rheumatic Diseases
6Birmingham University Medical School
7Lund University Medical School Sweden
Correspondence to:
Correspondence to A. J. Silman, ARC Epidemiology Research Unit, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT
Three different assessment methods for the classification of Raynaud's phenomenon (RP) were compared. These were (i) a previously validated method using colour charts supplemented with a short questionnaire, (ii) answers to a questionnaire based on criteria derived from the consensus opinion of a group of clinicians, and (iii) individual clinician's assessment using standard descriptions based upon the same consensus view. We report the results of a study involving six clinicians and 30 subjects investigating the level of repeatability between the three methods and also the reliability between the six clinicians. There did not exist any overall systematic bias between the six clinicians. Further, agreement between them, as assessed by the k statistic, ranged from moderate to good. However, there did exist systematic bias between the results from all three of the classification approaches with agreement between them ranging from only poor to moderate. We conclude that the previously validated colour chart assessment is too insensitive to detect RP. Further, a structured questionnaire based on perceived clinicians' opinion could not reproduce clinicians' classification in practice. By contrast, supplying clinicians with standard descriptions did yield a reliable classification system for RP.
KEY WORDS: Raynaud's phenomenon, Diagnosis, Individual clinician's assessment, Majority clinician assessment, Questionnaire, Colour chart
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